title: Procedure-type risk categories for pediatric and congenital cardiac catheterization.
abstract: BACKGROUND
  The Congenital Cardiac Catheterization Project on Outcomes (C3PO) was established to develop outcome assessment methods for pediatric catheterization.
  
  
  RESULTS
  Six sites have been recording demographic, procedural and immediate outcome data on all cases, using a web-based system since February 2007. A sample of data was independently audited for validity and data completeness. In 2006, participants categorized 84 procedure types into 6 categories by anticipated risk of an adverse event (AE). Consensus and empirical methods were used to determine final procedure risk categories, based on the outcomes: any AE (level 1 to 5); AE level 3, 4, or 5; and death or life-threatening event (level 4 or 5). The final models were then evaluated for validity in a prospectively collected data set between May 2008 and December 31, 2009. Between February 2007 and April 2008, 3756 cases were recorded, 558 (14.9%) with any AE; 226 (6.0%) level 3, 4, or 5; and 73 (1.9%) level 4 or 5. General estimating equations models using 6 consensus-based risk categories were moderately predictive of AE occurrence (c-statistics: 0.644, 0.664, and 0.707). The participant panel made adjustments based on the collected empirical data supported by clinical judgment. These decisions yielded 4 procedure risk categories; the final models had improved discrimination, with c-statistics of 0.699, 0.725, and 0.765. Similar discrimination was observed in the performance data set (n=7043), with c-statistics of 0.672, 0.708, and 0.721.
  
  
  CONCLUSIONS
  Procedure-type risk categories are associated with different complication rates in our data set and could be an important variable in risk adjustment models for pediatric catheterization.
authors.affiliation: Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, USA. Lisa.Bergersen@cardio.chboston.org
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Audrey
authors.initials: A
authors.lastname: Marshall
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kreutzer
authors.forename: Robert
authors.initials: R
authors.lastname: Beekman
authors.forename: Russel
authors.initials: R
authors.lastname: Hirsch
authors.forename: Susan
authors.initials: S
authors.lastname: Foerster
authors.forename: David
authors.initials: D
authors.lastname: Balzer
authors.forename: Julie
authors.initials: J
authors.lastname: Vincent
authors.forename: William
authors.initials: W
authors.lastname: Hellenbrand
authors.forename: Ralf
authors.initials: R
authors.lastname: Holzer
authors.forename: John
authors.initials: J
authors.lastname: Cheatham
authors.forename: John
authors.initials: J
authors.lastname: Moore
authors.forename: James
authors.initials: J
authors.lastname: Lock
authors.forename: Kathy
authors.initials: K
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012306:Risk